no Diseases of the Genital Orgajis 



tic, shows intense suffering and, as a rule, quickly succumbs. 

 Some of them, however, after remaining in an extremely 

 critical state for some days slowly improve but as a rule 

 never regain condition and must eventually be destroyed as 

 useless. 



Consequently in the instrumental examination of the 

 uterus, as in that of the cervix, ample care is always to be 

 taken to avoid rupture. Such care must be based upon ac- 

 curate anatomic knowledge, surgical skill, patience, and the 

 application of the invariable rule that, if the instrument can- 

 not be passed without the use of force, the effort must he 

 suspended. The cervical canal dilates during estrum, at 

 which time an instrument may far more readily be passed 

 into the uterus. If the operator desires, he may dislodge the 

 corpus luteum and return after three days with reasonable 

 assurance that he will find the patient in estrum and her 

 cervical canal dilated. If he will then use the dilators pru- 

 dently, he will leave the canal dilated and the angles modified 

 in a manner to render catheterization of the uterus less diffi- 

 cult if again undertaken in a few days. Aside from the diag- 

 nosis of estrum and the advantage of the dilated cervix fa- 

 cilitating the catheterization of the uterus, estrum is a very 

 poor time to examine the genitalia, because vagina, cervix, 

 and uterus are so filled with mucus, and the uterus so en- 

 larged and engorged that many pathologic conditions may 

 be so completely screened as to be wholly unrecognizable. 



When the catheter has entered the uterine cavity, the ex- 

 amination is to be completed by douching. For this purpose 

 I prefer a one to two per cent. Lugol's solution, rather than 

 sterile salt solution or other neutral liquid, because, in my 

 judgment, the disinfectant renders the operation safer, es- 

 pecially when any minor injury to the cervical or uterine 

 mucosa has occurred. The faintly brownish and clear fluid 

 serves to form a contrast with pus or muco-pus rendering 

 them more apparent. Physiologically the douche should re- 

 turn clear and uniform except that in estrum there should 

 first escape some clear mucus, and during the one or two 

 days following estrum, some partly clotted menstrual blood. 



